ABSTRACT: Most sex offender treatment programs require an admission of guilt for completing successful therapy. Not admitting guilt is interpreted as
denial. There are no scientific data suggesting that coerced admission of guilt has therapeutic efficacy. If required to complete a treatment program, this may be an impossible demand. Those wrongfully convicted suffer greater punishment if innocence is maintained. A specific prison based treatment program will be used to illustrate this approach and the consequences to those mandated iii to treatment and to the children involved. Suggestions are given for
treatment not requiring admission.

Denial in Sex Offenders

Most child sexual abusers rationalize and justify the sexual behavior that got them into difficulties. Some deny all aspects of the allegations, despite overwhelming evidence against them. Few at the beginning fully admit their inappropriate behavior, take responsibility for it, and understand the potential harm to the victim.

The excuses and justifications of sex offenders can be rationalization& for the sexual misbehaviors or they can reflect underlying cognitive distortions that allow the person to become sexually involved with a child. But, although there is disagreement as to whether the excuses and cognitive distortions are consequences rather than causes of the sexual misconduct, there is no dispute that they are important in understanding the offender. Carefully assessing the types of minimizations, justifications, and denials is universally regarded as important in the evaluation of child molesters and accepting responsibility for the one's behavior is a treatment goal in all programs.

We sampled 94 individuals who had engaged in sexual contact with a child. The sample consisted of persons who had been convicted, pled guilty or entered a plea bargain, acknowledged the abuse in family or juvenile court, or otherwise admitted the abuse. Persons who denied the abuse but were convicted or denied the abuse but accepted a plea bargain were included only if each of us believed, on the basis of the documents in the file, that the abuse was likely. The sample was taken from cases where we had conducted psychological evaluations, provided treatment, or analyzed documents which included information about the offender. We examined the records and recorded information about the individual, the nature of the adult-child sexual contact, and what was admitted about the behavior, along with any explanations, justifications, and excuses that were used to explain the behavior.

Table 1. shows the degree of admission of the abuse. Of the 94 offenders, only 8% acknowledged their behavior fully from the beginning, with 4% more admitting fully after an initial denial. The others either maintained their denials (11%), denied but accepted a plea bargain (10%), admitted innocuous touching but denied abuse (11%), or minimized the behaviors in some way (57%). Table 2 describes the types of minimizations that we found in the explanations of the offenders.

Extent of abuse
Harm to child
Blames child or other circumstance
Admits but justifies
Admits but says it is not sexual abuse

27
38
21
16
10

50%
70%
39%
30%
19%

Explanations Given for the Adult-Child Sexual Contact

Below are examples of the types of explanations we found in our sample. They are not exhaustive and most accounts fit into more than one category.

Fully admits behaviors

· After his 13-year-old foster daughter told her teacher about the abuse, he went to an attorney saying that he wanted to cooperate fully with the DA's office. When interviewed, he voluntarily described all of the incidents that he could recall. He was guilty, remorseful, and ashamed and and his ending statement to the police was basically, "I need help." When we evaluated him, he admitted what he had done and took responsibility for it.

· When his daughter disclosed the sexual abuse to a neighbor, the pastor reported the abuse and referred the family to us. The family came to us the next day. The father fully admitted his behavior with both daughters and was devastated by what he had done.

· The man, who was abusing both stepsons, felt he just could not control himself and made anonymous calls to therapists looking for help before the boys told. He was guilty, depressed, and remorseful and did not deny nor minimize his behavior. He pled guilty and was sentenced to prison and suicided the day he was transferred to prison.

· He (16-year-old boy) was wrestling with the 9-year-old sister of his best friend and suddenly put his hand down her pants and stuck his finger in her vagina. He was ashamed and embarrassed over what he did and concerned for the distress he caused the girl. He offered no excuses or minimizations.

· When first confronted by his wife about the abuse of the girl, he at first denied the allegations and then later admitted some of the improper activity. But by the initial police interview he fully admitted all of the abuse. He said that incest had been going on in his family for a very long time and that he was scared to tell anyone and was glad the child had told.

· He originally lied to his girlfriend about his sexual involvement with her daughters and left the state and made
a serious suicide attempt. But after this, he admitted it fully. When we saw him, he acknowledged complete
responsibility for his behavior and the situation he was in.

Complete denial of the abusive acts

· He denied sexually abusing his 6- and 8-year-old daughters and blamed others for his problems. He wrote long letters after his conviction where he referred to his attorney as a "narrow, conceited bigot," the counselor, detective, and CPS worker as "wrong and biased," and the prosecutor as showing the "zeal of the devil himself."

· He adamantly denied any sexual contact between himself and his grandchildren and said that he has a dysfunctional family and his sons have put their children up to this in order to get him for some reason.

· He flatly denied abusing the 11- and 12-year-old girls and said that the girls were prone to make up stories.

· He denied all sexual abuse. He had a different explanation for each of the allegations involving a variety of different children.

· He continued to deny having intercourse with his 14-year-old retarded stepdaughter even after a DNA test indicated that he was the father of the girl's baby. He blamed it instead on the child's 76-year-old great uncle.

· He completely denied abusing any of several children and produced elaborate notes and drawings and explanations to prove why the allegations were untrue.

Admitted the behaviors but does not consider them to be abusive

· He justified having intercourse with his 14-year-old daughter it by saying they were "in love." In fact, he felt he was cheating on his daughter if he had intercourse with his wife.

· He admitted the sexual behaviors but didn't feel it was wrong as he cared for the boys (from deprived homes in an underdeveloped country that he brought to
his home) and provided a good life for them. He said that he "wanted to help them." He was never conflicted psychologically about his attraction to young boys but was upset over the difficulties this has caused him and the responses of others to his behavior.

· He fondled and had oral sex with children that he befriended. He didn't think he hurt them. He saw himself as being gentle and nice to them and trying to do good things for them. He believed he was loving them.

· He admitted mutual masturbation with several 14- to 17-year-old boys but the boys were from troubled families and he felt he was caring for them and that it was mutual. He said that he didn't do anything sexual with the boys unless they cared for him and wanted the sexual contact.

· He admitted masturbating and fondling his 13-year-old stepson but said that it felt mutual, as though they were peers, and it didn't seem wrong.

· He fully admitted fondling and having oral sexual contact with prepubescent boys but believed there was nothing wrong with what he does and that society is at fault. He maintained that pedophilia is acceptable as long as the pedophile loves and respects the child and that sex between an adult and a boy is not harmful and is a healthy expression of sexuality.

Admitted the behavior but said it was therapy or education

· He admitting showing his retarded adopted son how to masturbate because the boy had physical and emotional problems and had difficulty masturbating. He said that the boy, who had cerebral palsy, may have swayed and accidentally got semen on his lips during this.

· He admitted letting his stepdaughters see and touch his penis but said he did this for sex education.

· He was trying to "teach the child a lesson." He felt that by rubbing his stepdaughter's breasts he would decrease what he felt was her inappropriate sexual acting out behavior of wiggling around on the laps of men.

· He exposed himself to his two daughters, ages 11 and 13, and masturbated in front of them in order to educate them about sex.

· He had the boys in his confirmation class and at church camp expose their penises and he engaged in discussions about circumcision, masturbation, sexual activities, etc. He also tickled, massaged, and fondled their penises. He said he was teaching them about sex.

· He fondled his daughter and made her masturbate him to orgasm but said it was for sex education and for her benefit. He said that she had great curiosity about sex and looked older than she was. He wanted her to develop a healthy sexuality and was afraid she wouldn~t have orgasms so he stimulated her until she did. One time, after he had ejaculated, he had her look at the ejaculate under the microscope.

· He (a psychiatrist) masturbated several boys in the hospital ward to orgasm, claiming it was therapeutic. He maintained that the masturbation to orgasm was "helpful" and did not harm the boys because "I did it clinically and discretely."

· He admitted fondling and sleeping naked with his 8-year-old foster daughter and letting her touch his erect penis but justified it as "innovative treatment" for his child's sexual acting out. He developed a "safety valve" theory where he determined to let the child ventilate her sexual obsessions in order to free her of them.

· He performed oral sex on his 8-year-old granddaughter to show her exactly how serious things could get so she would stop her sexual behavior. "I figured that it was better for me to do something than her to do the same thing she was doing with me with a neighbor or someone who would rape her, and that's the
truth."

Admits innocuous behavior but denies abuse

· He admitted taking showers with his daughter and stepdaughter, kissing them on the mouth, and walking around naked but denied sexual abusing them.

· He admitted forcing his 8-year-old stepdaughter to get into the bathtub with him but he denied having her touch his genitals and performing oral sex on her.

· He admitted to accidentally exposing himself when he went to get a towel after a
shower, to using a washcloth to clean one child's vagina, and wrestling with one child, but he denied the allegations
of sexual abuse by several different girls who were friends of the family or babysitters.

· He admitted holding the child on his lap in the car and tickling her in the ribs but denied fondling her genitals.

· He admitted wrestling with boys in his Scout troop and discussing sexuality and homosexuality with them but denied fondling them.

· He admitted teaching the child how to clean his penis but denied fondling him.

· He admitted letting his daughter see him naked and touching his penis but denied fondling and oral sex.

· He maintained that he touched the boy's genitals when his wife asked him to check the
boy's undescended testicles but he denies touching the boy for sexual gratification and pleasure.

He admitted only that he bathed the boys and taught them how to clean their penises.

Admitted the behavior but didn't think it hurt the child

· He admitted making the girl suck his penis but he didn't think it was a big deal and he didn't realize he was hurting the child. He said he did it because he was curious juvenile offender).

· He admitting fondling and performing oral sex on his young stepsons but said that he did not believe his behavior had hurt them.

· He was persuaded that fondling and masturbating the penises of young boys in his Boy Scout troop was teaching the boys a healthy sexuality and a healthy attitude towards their penises and arousal.

· Although he admitted anally penetrating several boys he had no understanding of the impact on the children and did not care about anything other than getting in trouble.

· He admitted what he did (raping teenage girls) but minimized its seriousness and said that the victims were
"willing," because they "didn't struggle."

· He admitted touching the legs or thighs of children he believed were asleep and ejaculating or masturbating but, although he admitted doing this to at least 25 girls, he didn't believe it hurt them because they were unaware of what he was doing.

· He admitted regularly engaging in frottage with young adolescent boys who were strangers but he did not believe this was harmful to them.

Admitted the behavior but minimizes extent or frequency

· He admitted touching his 4-year-old daughter's vagina with his penis but he insisted it only happened once. He said he didn't know how it happened.

· He (a 13-year-old boy who admitted forcing a 3-year-old girl to perform oral sodomy) said, "I heard about it in school and all of a sudden it happened." He claimed there was no planning or forethought, that they 'just did it for a second."

· He admitting one instance of fondling a neighbor girl but he said this was the only time he had done anything like this.

· He said that the boy greatly exaggerated the reports of the frequency and extent of the behavior (fondling and oral sex). He also maintained that he had never had sexual fantasies concerning a child or abused any other child and insisted he is completely heterosexual.

He admitted holding the boy on his lap and fondling him but denied oral sex and mutual masturbation.

· He admitted fondling and having oral sex with his stepson but denied the allegations concerning his own children.

Admitted the abusive acts but blamed the child

· He admitted that he kissed the child "on the buns" a lot, including in front of the mother, but said that the child asked him a lot of things about sex. He said that the child came up to him and squeezed his penis. He said that the child initiated kissing on the front (vagina) because she would do anything for him if he married her mother.

· He (15-year-old boy) admitted attempting intercourse with his 9-year-old half-sister but said she was "willing."

· He initially denied all of the allegations by his adopted 14-year-old daughter and said that the child was a sexual girl and is mentally ill. He said that her statements about abuse were falsehoods either induced or supported by the staff at the runaway shelter. (He eventually acknowledged that the allegations were true.)

· He admitted kissing and licking his 8-year-old granddaughter her all over her body and
licking her vagina but he said that she initiated all of the incidents and that she was the one that kept coming on to him. "She does things like a teenager would do."

· He said that he he found the boy on top of the girl and "gave them hell" and made them continue it as a way of punishing them. In addition, he told the children's mother that they were curious and he showed them how it was done.

· She acknowledged having intercourse with her 13-year-old foster child but claimed that he first raped her and then forced her to continue by threatening to tell her husband if she stopped having regular intercourse with him.

· He admitted having intercourse with a 16-year-old foster daughter but blamed the girl, saying that she "blackmailed" him into it.

· He felt his 13-year-old sister-in-law girl was "coming on to him" and that exposing himself to her was no big deal.

· He said that if the child had not French kissed him he would not have abused her. He also accused another girl of wanting him to sexually abuse her.

Admitted the abusive acts but blamed others

· He blamed his father for the fact that he (a 16-year-old boy) sexually abused the 9-year-old boy he was babysitting for. He said he performed oral sex on the boy because he was angry at his father and thinking about sex all of the time.

· He fondled and masturbated his 14- and 16-year-old stepsons. He blamed his attraction to young boys on a childhood experience with a college boy and on the fact that his parents made their children afraid of them.

· He explained that his wife drank too much and would pass out and not have sex with him and this is why he turned to his daughter.

· She admitted inserting a dildo into her 13-year-old daughter but said that her husband was involved in this also. (Both the girl and the stepfather denied his involvement.)

· He acknowledged fondling a 7-year-old neighbor girl but blamed his wife, saying that she was withholding sex and he couldn't handle it.

· He said that his wife went along with the touching and fondling of his stepdaughter.

· He blamed his abuse of his stepson on the stress he was experiencing by being married to a difficult, rejecting, and controlling woman.

· He saw himself more as a victim (because of his childhood abuse) than as an abuser and felt very sorry for himself. He didn't think his lawyers are trying hard enough and he didn't believe he was getting a "fair shake" from the court. He thought his sentence of a year in jail was too much and he was bitter about this. He said he was being punished for telling the truth and that he was paying for everyone else's sexual abuse.

Blames other factors

· He masturbated in front of the boy because of mental confusion brought on by high sugar because of his diabetes.

· He said he could not recall touching the child in a sexual manner. When asked why she said it, he said "It evidently has to be true . . she doesn't make stories up, so when she says it, then it has to be true." But he maintained that he could not remember touching her because he had blackouts.

· He did not dispute the allegations by several nieces and grandchildren that he had fondled and performed oral sex on them but he maintained he could remember nothing about any of the episodes because he was drunk.

· He lost his temper when he came home and found the babysitter partying and drinking beer while his daughter lay unattended crying in her crib. He sent the others home and told the babysitter she wasn't leaving until she fed and cared for the baby properly. He was very angry and slapped her and lectured her. He then told her to go into the bedroom and take her pants down and "give me a blow job."

Said that if improper touching happened it was by accident.

· He (3rd grade teacher) said that the boys liked to sit on his lap and be hugged and kissed. They asked him to "rub their tummies" and he may have touched their genitals "by accident." He denied rubbing their genitals for sexual reasons and denied sexual fantasies involving children.

· He just hugged her and if he touched her breasts it was completely by accident.

· He admitted bathing with his 2-year-old child, getting an erection and hugging her while naked, and masturbating afterwards, but he said that if his penis slipped into her it was by accident.

Accused But Innocent

An individual who is accused may also be innocent. With the high base rate of false positives in the child abuse system as currently structured, this possibility cannot be disregarded or dismissed. If the accusation is false a citizen has a heavy and dangerous burden to overcome, that is, the assumption that anybody accused is guilty. When a requirement of an admission of guilt is added to the system at any point, additional dangers must be faced. These include prosecutorial prejudice in charging, any potential plea
bargaining (Holmgren, 1998), judicial hostility, jury bias, harsher and longer sentences, greater difficulty in any consideration of probation or parole
(Dagher-Margosian, 1995) and increased jeopardy from guards and inmates if imprisoned (Pence, 1993). Potential consequences may also extend to spouses and children. Innocent spouses are threatened with termination of parental rights (Patton, 1990) and children are placed in foster care, often for years with many moves from placement to placement.

Sex Offender Treatment Requiring Admission of Guilt

Convicted sex offenders may be required to participate in a sex offender treatment program in order to be paroled. If the inmates refuse to participate in the treatment program they may be exposed to various sanctions, consequences, and threats. Such treatment programs often require an admission of guilt as part of the therapeutic regimen. Persons who deny the offense are considered untreatable and likely to recidivate
(Holmgren, 1998). In family court, there may be contingencies such as no visitation with a child until there is an admission of guilt. We have seen cases where parents who do not admit to the abuse are declared untreatable and their parental rights terminated.

But there are no scientific data supporting the therapeutic efficacy of requiring an admission of guilt. A review of the scientific literature dealing with this issue demonstrates that, in fact, such imposition of the moralism of the treatment program is countertherapeutic and prevents healing and positive changes for the persons subjected to such a treatment requirement (Adams, 1998; Levine & Doherty, 1991; Wakefield & Underwager, 1991).

There is no justification for requiring an admission of guilt in order to benefit from therapy. The research showing the methods of therapy that are effective and succeed in reducing recidivism are those that proceed along individualized, behavioral, and cognitive directions (e.g., Nagayama Hall, 1995a; Laws, 1989; Simon, 1998; Wakefield & Underwager, 1991).

A sex offender who minimizes or even denies the offense is treatable. Sex offenders routinely deny their offense when first confronted. Even following a conviction, they often deny, distort, justify, or minimize their behavior (Ward, McCormack, Hudson, &
Polaschek, 1997). Several researchers have described treatment programs with sex offenders who deny their guilt (Maletzky, 1996; O'Donohue &
Letourneau, 1993; Schlank & Shaw, 1996; Winn, 1996).

Denial of the offense does not affect the risk of recidivism. A recent meta-analysis of sexual offense recidivism (Hanson &
Bussičre, 1998) found several factors that predicted sexual offense recidivism but denial of the offense was not one of them.

Several state appellate and Supreme Courts have ruled that requiring an admission of guilt as a necessary part of a therapeutic program is a violation of the Fifth Amendment rights of citizens (Adams, 1998; Dickson, 1991; Patton, 1990: Levine& Doherty 1991). There really is no dispute in the courts regarding the coercive nature of requiring parents to confess in court ordered or required therapy as a condition of access to a child or retaining parental rights (Patton, 1990). Levine & Doherty (1991) conclude:

The process of forcing an untrue admission violates both human dignity and the integrity of the person. The policies underlying the Fifth Amendment are of concern to psychotherapists as well as the legal profession. The difficulty exists for both therapist and client and needs to be treated sensitively with a concern for both therapeutic interests and legal consequences (p.110).

Treating Child Sexual Offenders Who Deny Their Behavior

Most commentators on the research evidence on child molesters observe a major role of adult cognitive distortions in the behaviors in adult child sexual contact. A number of attempts to assess the extent, scope, and content of the cognitive distortions have been described (e.g., Abel, Becker, &
Cunningham-Ratner, 1984; Bumby, 1996; Knight, Prentky, & Cerce, 1994). Varying perceptions of the role of the cognitive distortions in the behavior appear in the literature with most seeing the distortions as both a cause and an effect. Cognitive distortions are learned beliefs, values, and self statements used to deny, minimize, justify, excuse, and rationalize adult child sexual contact. They also reduce personal responsibility, make the behavior acceptable, and avoid guilt, shame, or anxiety that might otherwise be connected with behaviors outside the norm of conventional standards (Hanson,
Gizzarelli, & Scott, 1994; Stermac & Segal, 1989; Malamuth, 1984).

The claim of love for children is the primary cognitive distortion to be found in the meaning system of child molesters. It is basic to the awareness of humanity and fundamental to the quality of relationships. When the perception of reality is shaped by the belief that what goes on between an adult and a child sexually is love, all other cognitions which support transgenerational sexuality flow from that core conviction. Therefore our treatment approach begins there.

Even though the current research on the effects of sexual abuse suggests that the
observable psychological damage is much less than has generally been thought
(Bauserman & Rind, 1997; Rind Tromovitch, & Bauserman, 1998), this does not mean that sexual contact with an adult is harmless (Wakefield & Underwager, 1994). There are many ways that such contact can be harmful in the absence of measurable emotional damage.

Engaging in behaviors that harm children cannot be loving them. Any adult-child sexual contact is destructive and can only teach the child a genitalized understanding of human sexuality. A consequence may be a weakened ability to experience full intimacy and closeness to others. It is vital to deal with the harm done to children. "Treatment of sex offenders will need to emphasize the harm done to victims and should include educational/persuasive components designed to counter the cognitive distortions evident in some perpetrators" (Briggs & Hawkins, 1996, p.232).

Treatment procedures

Our treatment program begins with a thorough and careful assessment and evaluation. We spend two or three full days in psychological testing, clinical interviews, and pursuing any concepts which seem individual or unique. The tests we use include MMPI-2, MCMI-III,
MSI, CPI, MBTI, a Shipley Hartford or WAIS-R, a sentence completion form, an adjective check list, and a biographical data sheet. We may include a cognitive distortion instrument although we have not found them very useful. Any other tests which may be helpful in assessing a given individual may be added initially or later in the treatment regimen.

We take a detailed family, social, and sexual history looking for the nature and quality of learning experiences that may be relevant to the understanding of intimacy and love. Part of our interest is also in finding the strengths and competencies an individual possesses. In all therapy we have maintained that in order to work on problems it is essential to know what the strengths are since those are the tools the individual has to address the problems.

We develop an individualized program of treatment that acknowledges the strengths of the individual. An overarching concern is also to address the level of self confidence. Low self-esteem both may be a major factor in causing the sexual behavior and an obstacle to any behavior change. To change, persons must believe they are capable of
change (Marshall, 1996).

We next address the nature and quality of intimate human relationships. We provide material and homework assignments that respond to what we have learned about the individual. We use didactic materials,
bibliotherapy, structured assignments, and individualized therapy sessions that are aimed at reattribution and cognitive restructuring. Wherever possible, we also use behavioral homework assignments that are part of ongoing interpersonal relationships or will guide the individual through the development of new interpersonal relationships.

When the individual has reached an awareness of the nature of intimacy, we move to didactic presentations of the potential harm done to children by reinforcing and teaching a genitalized view of sexuality. We present the possibility that a long-term effect of the abuse may be to limit the ability of the child to later have a healthy intimacy and closeness in his or her relationships.

With this potential for long-term negative impact clear, we then deal with any other cognitive distortions. Here, too, where possible behavioral homework assignments are designed and implemented. This may include restructuring of masturbation fantasies as well as any appropriate sexual relationships.

When a satisfactory level of response to the initial cognitive restructuring has been reached, we move to a relapse prevention approach. Here we follow the program of Laws (1989,
1995) and Pithers and Cumming (1989). Following relapse prevention we again use didactic material and behavioral homework assignments.

While we have not kept a systematic record of the child sexual abusers whom we have treated, we know of only one who repeated sexual contact with a child. This is a man with a completely chaotic sexuality who dropped out of our individualized treatment program claiming he did not need it any more. He went to a county sponsored group therapy sexual offender program. Within ten months he recidivated.

Dealing with Continued Denial

It is not necessary to challenge, confront, terminate from treatment, or accuse those who maintain innocence. We suggest acknowledging their claim of innocence but continuing to deal with the initial and basic cognitive distortion. The goal is to reduce harm to everyone, including the patient. This goal is served by getting clear on the human drive to intimacy and community and the quality of human sexuality. The person can hope for more rewarding personal relationships and avoid using others or getting involved in unrewarding and partial sexual expressions. The strategy is to reinforce positive behaviors and decelerate negative behaviors.

In addition, the techniques of relapse prevention can be used in terms of situations where the person may be vulnerable to an accusation in the future. The person is told that it is not enough to avoid engaging in sexually abusive behaviors, he must avoid situations where he may be accused of it. He must be confronted with the reality that, once convicted of child sexual abuse, he will forever be more vulnerable to misinterpretation of
his behavior and to receiving another accusation.